Provider Demographics
NPI:1386039428
Name:WOOTEN, ANGELA ROBIN WYATT (LCMHC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:ROBIN WYATT
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:LCMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 OLD MOCKSVILLE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-1951
Mailing Address - Country:US
Mailing Address - Phone:704-360-3637
Mailing Address - Fax:704-200-9829
Practice Address - Street 1:276 OLD MOCKSVILLE RD STE 100
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-1951
Practice Address - Country:US
Practice Address - Phone:704-360-3637
Practice Address - Fax:704-200-9829
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11555101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health